2004 OPEN FORUM Abstracts
MULTI-HOSPITAL OUTCOMES COMPARING THE USE OF NASOPHARYNGEAL SUCTION (NPS) WITH A CATHETER VS AN OLIVE-TIPPED DEVICE (OTD) IN SUCTIONING BRONCHIOLITIS PATIENTS.
Bennion BS RRT, Julie Ballard BS RRT, Scott Daniel RRT, and
Debbie Forbush BS CRT, Respiratory Care Services, Dixie Regional
Medical Center, St. George, Utah.
Introduction: Our facility teamed with three other Intermountain Health Care (IHC) medical centers in the implementation of a bronchiolitis clinical practice guideline (CPG). The CPG specified utilizing the nasopharyngeal suction (NPS) technique of using a catheter inserted through both nares & into the hypopharynx. It was our impression that using an olive-tipped device (OTD) which uses suction but does not advance into the hypopharynx would be as effective. We sought to test this assumption.
Methods: The Bronchiolitis Score (BS) is a respiratory symptom-based scoring system used to define respiratory distress & patient (pt) response to interventions. The BS is based on respiratory rate, breath sounds & retractions, each being scored on a scale of 0-3. An improvement in the BS was defined as a decrease in the total score by > 1 from pre- to post- NPS. Data on suction interventions & scores were retrospectively extracted from the departmental bronchiolitis databases for the 2002-2003 season (defined as Nov. 1-April 30). Inclusion criteria were: (1) diagnosis of bronchiolitis, (2) age < 24 months, (3) NPS during their non-intensive care hospital admission, and (4) a complete set of scores (baseline and post suction). Pts were scored according to whether their scores improved, remained unchanged or worsened after each suctioning episode.
Results: Our facility was unable to replicate the results found at the other IHC medical centers. Outcomes comparing the 2002-2003 season utilizing the OTD vs the catheter at 4 IHC hospitals in Utah are reported in Table One. Chi square analysis was performed with P < 0.05.
Table One: 2002-2003 Catheter vs OTD Utilization Between Four Utah Regional Medical Centers
|Pt Response to NPS Events||PCMC (catheter) # (%) NPS||UVRMC (catheter) # (%) NPS||MKD (catheter) # (%) NPS||DRMC (OTD) # (%) NPS|
|Improved||1730 (61)||534 (71)||345 (50)||202 (26)|
|No Change||992 (35)||201 (27)||291(42)||478 (63)|
|Worsened||124 (4)||20 (2)||53 (8)||82 (11)|
|Total # NPS Events||2846 (100)||755 (100)||689 (100)||762 (100)|
Our failure to replicate the approximate 50% of pts who improved with
NPS with a catheter at 3 other IHC medical centers, lends validity to
their impression that suctioning with a catheter appears to be a
superior technique when suctioning bronchiolitis pts. We implemented
a comprehensive training program to standardize the NPS technique
with a catheter & removed the OTD from our floor stock for the
2003-2004 season. The value of benchmarking & outcomes reporting
to identify & improve processes cannot be over emphasized.